Lack of Correlation Between Doppler and Catheter in Pulmonary Pressure: Flawed Noninvasive Technique or Straw Man

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The American journal of cardiology (Impact Factor: 3.28). 10/2010; 106(7):1059-60; author reply 1060. DOI: 10.1016/j.amjcard.2010.07.006
Source: PubMed
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    ABSTRACT: The aim of this study was to evaluated an alternative echocardiographic method to calculate mean pulmonary arterial pressure (MPAP). One hundred two patients were studied with simultaneous right-heart catheterization (RHC) and echocardiography. MPAP was calculated by adding the right ventricular-right atrial mean systolic gradient to right atrial pressure. The mean difference between MPAP calculated using this method and RHC-derived MPAP was -1.6 mm Hg, less than that of traditional systolic pulmonary arterial pressure (SPAP; -6.4 mm Hg) and MPAP estimated using the pulmonary regurgitation method (-13.9 mm Hg). The median absolute percentage difference of the MPAP calculations relative to RHC was significantly less with this method than with the pulmonary regurgitation method (18% vs 71%; P < .001) and similar to the SPAP method (both 18%; P = .30). MPAP calculated using the proposed method is as accurate as SPAP calculation and less variable than previous methods, thus allowing widespread clinical use.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 06/2009; 22(7):814-9. DOI:10.1016/j.echo.2009.04.007 · 4.06 Impact Factor
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    ABSTRACT: The noninvasive estimation of pulmonary artery systolic pressure (PASP) has become a standard component of the echocardiographic examination. Our aim was to evaluate the accuracy of this modality in a large series of unselected studies obtained in clinical practice. All right heart catheterizations during a 4-year period were reviewed. Studies with echocardiographic findings available within 48 hours were evaluated for PASP agreement. In an effort to mirror clinical practice, the right heart catheterization findings were used as the reference standard and the PASP values were taken directly from the respective clinical reports. Overall, 792 right heart catheterization-echocardiogram pairs were identified. Echocardiographic PASP could not be estimated in 174 of these studies (22.0%). The correlation between modalities was moderate, but agreement was poor (bias 9.0%, 95% limits of agreement -53.2% to 71.2%, r = 0.52, p <0.001). Misclassification of clinical PASP categories occurred more often than not (54.4%). Multivariate analysis using multiple potential sources of error could only account for 3.2% of the total variation in the discrepancy between the study modalities (p = 0.003). In conclusion, noninvasively estimated PASP had limited agreement with the invasively determined PASP, and misclassification of PASP clinical categories occurred frequently. Given the widespread use of echocardiographically determined PASP, these data are in need of replication in a large prospective study.
    The American journal of cardiology 04/2010; 105(8):1192-7. DOI:10.1016/j.amjcard.2009.11.048 · 3.28 Impact Factor
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    ABSTRACT: To evaluate a simple noninvasive means of estimating right atrial (RA) pressure, the respiratory motion of the inferior vena cava (IVC) was analyzed by 2-dimensional echocardiography in 83 patients. Expiratory and inspiratory IVC diameters and percent collapse (caval index) were measured in subcostal views within 2 cm of the right atrium. Parameters were correlated with RA pressure by flotation catheter within 24 hours of the echocardiogram (38 were simultaneous). Correlations between RA pressure (range 0 to 28 mm Hg), expiratory and inspiratory diameters and caval index were 0.48, 0.71 and 0.75, respectively. Of 48 patients with caval indexes less than 50%, 41 (89%) had RA pressure greater than or equal to 10 mm Hg (mean +/- standard deviation, 15 +/- 6), while 30 of 35 patients (86%) with caval indexes greater than or equal to 50% had RA pressure less than 10 mm Hg (mean 6 +/- 5). Sensitivity and specificity for discrimination of RA pressure greater than or equal to or less than 10 mm Hg were maximized at the 50% level of collapse. Thus, IVC respiratory collapse on echocardiography is easily imaged and can be used to estimate RA pressure. A caval index greater than or equal to 50% indicates RA pressure less than 10 mm Hg, and caval indexes less than 50% indicate RA pressure greater than or equal to 10 Hg.
    The American Journal of Cardiology 09/1990; 66(4):493-6. DOI:10.1016/0002-9149(90)90711-9 · 3.28 Impact Factor